Implementation and Impact of a Dedicated Geriatric Service: A Service Improvement Study.

چکیده اصلی

AIM: To design, implement, and evaluate a consultant-led Comprehensive Geriatric Assessment (CGA) service within an Irish private acute hospital, where structured geriatric models are not routinely embedded. The study examined the early operational and clinical impact of the service on care delivery for hospitalised adults aged ≥75 years. METHODS: A retrospective service-improvement audit was conducted involving 50 consecutive inpatients aged ≥75 years admitted to acute medical wards following introduction of a consultant-led geriatric service. Data were extracted from electronic health records using a structured audit tool aligned with the Health Service Executive (HSE) Model of Care for Older People, National Clinical Programme for Older People (NCPOP) quality standards, and the British Geriatrics Society Silver Book II. Primary outcomes were (1) time to first geriatric review and (2) proportion of patients reviewed within 48 hours. Secondary outcomes included multidisciplinary team (MDT) involvement, length of stay (LOS), discharge destination, and 30‑day readmission. Post‑implementation outcomes were descriptively compared with aggregated hospital activity data from the 12 months preceding service introduction. RESULTS: The mean age of patients was 82.6 years (SD 5.1), and 29 (58%) were female. The median time to first geriatric review was 29 hours, with 42 (84%) patients assessed within 48 hours of admission. MDT involvement was documented in 35 (70%) patients, compared with an estimated pre-implementation baseline of 22 (45%). The mean length of stay was 6.8 days, compared with a historical institutional estimate of 8.7 days derived from pre-service hospital activity data, representing an approximate 22% reduction. Discharge directly home occurred in 33 (66%) patients, while 5 (10%) were readmitted within 30 days. Staff survey responses (50) demonstrated high awareness of the service among 44 (88%) respondents and a perceived improvement in discharge coordination in 41 (82%). CONCLUSIONS: Introduction of a dedicated geriatric service in a private acute Irish hospital was associated with earlier specialist review, high multidisciplinary engagement, and favourable discharge outcomes. These findings support further development of CGA-aligned services within the private healthcare sector.

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